Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although the...Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.展开更多
Background: The Implantable Cardiac Monitor (ICM) is an invaluable tool for detecting cardiac arrhythmias by providing physicians. Critical to the success of ICMs depends on how quickly and accurately the data can be ...Background: The Implantable Cardiac Monitor (ICM) is an invaluable tool for detecting cardiac arrhythmias by providing physicians. Critical to the success of ICMs depends on how quickly and accurately the data can be transmitted to a physician’s office after an arrhythmic event. Then, the clinical event can be analyzed and the treatment will be provided accordingly. However, no reports have been published as to how efficiently the ICM data is transmitted. Methods: There is a retrospective review of 520 patients who received a Medtronic Reveal LINQTM between 2/01/2015 and 6/01/2017. The time from the arrhythmic event to the time of physician notification was calculated and reason for delay was noted. Results: One hundred and twenty patients out of 520 patients (23%) had arrhythmic events transmitted over a mean follow up of 14 ± 4 months. The mean time between cardiac events and physician notification was 15 ± 8 days. Sixty-three percent (63%) of data transmission delay (defined as >24 hours) was due to the MyCareLinkTM Monitor not being in proximity to the patient. Connection failure between the monitor and the network accounted for 34% of data transmission delay. Conclusion: Significant delay in data transmission from Medtronic Reveal LINQTM cardiac monitor occurs frequently impacting patient care. Newer generations of the implantable cardiac monitors utilize Bluetooth technology, enabling immediate transfer of data from ICM to a patient’s cellular phone and subsequently to their physician’s office. This technology could potentially improve efficiency and reliability eliminating the issues of proximity and connectivity.展开更多
Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patie...Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.展开更多
Pulseless Electrical Activity (PEA) and aystole are the most common initial rhythms in patients with in-hospital cardiac arrest. Respiratory failure is the most common cause for Rapid Response Team alert, and may be t...Pulseless Electrical Activity (PEA) and aystole are the most common initial rhythms in patients with in-hospital cardiac arrest. Respiratory failure is the most common cause for Rapid Response Team alert, and may be the initial cause for in-hospital cardiac arrests. Although cardiac monitoring is shown to be ineffective in identifying patients at risk for cardiac arrest, it is the most common monitoring used on the wards. As many of the cardiac arrests may have a respiratory origin, respiratory monitoring could identify patients at risk to develop cardiac arrest. Reclassifying cardiac arrests as primary cardiac and secondary would help in identifying secondary causes, and monitoring that could help in early identification of deterioration.展开更多
Objective:To make and study computed system for external cardiac massage,monitor of heart and body temperature and observe its clinical effect.Method:The system was made and applied.Result:The effect of system was obv...Objective:To make and study computed system for external cardiac massage,monitor of heart and body temperature and observe its clinical effect.Method:The system was made and applied.Result:The effect of system was obvious.Conclusion: The system was an effective clinical equipment in treatment of patient with cardiac arrest.展开更多
Background: With the rapid aging of society, the number of patients with heart failure has also increased. Implantable devices for heart failure have become standardized. Remote monitoring using cardiac devices has gr...Background: With the rapid aging of society, the number of patients with heart failure has also increased. Implantable devices for heart failure have become standardized. Remote monitoring using cardiac devices has grown in popularity for medical efficiency and the early detection of abnormalities. Our first aim was to develop a tablet-PC-based nursing intervention program for patients requiring remote monitoring of implantable cardiac devices. The second purpose was to evaluate the efficacy of the program by using mixed-methods research. Methods: The study consisted of two phases. In phase 1, we designed a tablet-PC-based nursing intervention program, on the basis of a literature review and qualitative data collected via semi-structured interviews. In phase 2, we conducted a randomized controlled trial that served as a preliminary investigation of the program. The outcome measures were readmission, unexpected visits to the clinic for heart problems, quality of life, self-care behavior, and self-efficacy. After the study, we interviewed each participant about his or her experiences with the program. Interviews were audio recorded, coded, and thematically analyzed. Results: The 33 patients with heart failure were randomized into two groups as follows: 17 patients in the telenursing group and 16 in the control group. During 6 months of follow-up, the readmission for heart failure occurred in 11% of the intervention group and 18% of the control group. There were no statistically significant differences between the groups at any outcome measures. Three themes were extracted via qualitative analysis: “getting a sense of safety,” “triggering a health behavior change,” and “feeling like a burden.” Conclusion: No improvements in rates of rehospitalization or unexpected clinic visits were seen in the quantitative study. However, signs of behavior modification were seen in the qualitative study. This program has the possibility of improving patient outcomes.展开更多
Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation proce...Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO2 measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO2 levels allows evaluation of the accuracy of the tcPCO2 technique for use during jet ventilation. Design: Observational study;patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO2 (EtCO2) and transcutaneous CO2 (tcPCO2) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO2 (PaCO2) levels and tcPCO2 were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO2 values consistently provided a close approximation to PaCO2 levels. The mean difference between tcPCO2 and EtCO2 values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO2 provides an acceptable estimate of CO2 concentration in arterial blood during JV, as well as prior to and following JV.展开更多
文摘Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.
文摘Background: The Implantable Cardiac Monitor (ICM) is an invaluable tool for detecting cardiac arrhythmias by providing physicians. Critical to the success of ICMs depends on how quickly and accurately the data can be transmitted to a physician’s office after an arrhythmic event. Then, the clinical event can be analyzed and the treatment will be provided accordingly. However, no reports have been published as to how efficiently the ICM data is transmitted. Methods: There is a retrospective review of 520 patients who received a Medtronic Reveal LINQTM between 2/01/2015 and 6/01/2017. The time from the arrhythmic event to the time of physician notification was calculated and reason for delay was noted. Results: One hundred and twenty patients out of 520 patients (23%) had arrhythmic events transmitted over a mean follow up of 14 ± 4 months. The mean time between cardiac events and physician notification was 15 ± 8 days. Sixty-three percent (63%) of data transmission delay (defined as >24 hours) was due to the MyCareLinkTM Monitor not being in proximity to the patient. Connection failure between the monitor and the network accounted for 34% of data transmission delay. Conclusion: Significant delay in data transmission from Medtronic Reveal LINQTM cardiac monitor occurs frequently impacting patient care. Newer generations of the implantable cardiac monitors utilize Bluetooth technology, enabling immediate transfer of data from ICM to a patient’s cellular phone and subsequently to their physician’s office. This technology could potentially improve efficiency and reliability eliminating the issues of proximity and connectivity.
文摘Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.
文摘Pulseless Electrical Activity (PEA) and aystole are the most common initial rhythms in patients with in-hospital cardiac arrest. Respiratory failure is the most common cause for Rapid Response Team alert, and may be the initial cause for in-hospital cardiac arrests. Although cardiac monitoring is shown to be ineffective in identifying patients at risk for cardiac arrest, it is the most common monitoring used on the wards. As many of the cardiac arrests may have a respiratory origin, respiratory monitoring could identify patients at risk to develop cardiac arrest. Reclassifying cardiac arrests as primary cardiac and secondary would help in identifying secondary causes, and monitoring that could help in early identification of deterioration.
文摘Objective:To make and study computed system for external cardiac massage,monitor of heart and body temperature and observe its clinical effect.Method:The system was made and applied.Result:The effect of system was obvious.Conclusion: The system was an effective clinical equipment in treatment of patient with cardiac arrest.
文摘Background: With the rapid aging of society, the number of patients with heart failure has also increased. Implantable devices for heart failure have become standardized. Remote monitoring using cardiac devices has grown in popularity for medical efficiency and the early detection of abnormalities. Our first aim was to develop a tablet-PC-based nursing intervention program for patients requiring remote monitoring of implantable cardiac devices. The second purpose was to evaluate the efficacy of the program by using mixed-methods research. Methods: The study consisted of two phases. In phase 1, we designed a tablet-PC-based nursing intervention program, on the basis of a literature review and qualitative data collected via semi-structured interviews. In phase 2, we conducted a randomized controlled trial that served as a preliminary investigation of the program. The outcome measures were readmission, unexpected visits to the clinic for heart problems, quality of life, self-care behavior, and self-efficacy. After the study, we interviewed each participant about his or her experiences with the program. Interviews were audio recorded, coded, and thematically analyzed. Results: The 33 patients with heart failure were randomized into two groups as follows: 17 patients in the telenursing group and 16 in the control group. During 6 months of follow-up, the readmission for heart failure occurred in 11% of the intervention group and 18% of the control group. There were no statistically significant differences between the groups at any outcome measures. Three themes were extracted via qualitative analysis: “getting a sense of safety,” “triggering a health behavior change,” and “feeling like a burden.” Conclusion: No improvements in rates of rehospitalization or unexpected clinic visits were seen in the quantitative study. However, signs of behavior modification were seen in the qualitative study. This program has the possibility of improving patient outcomes.
文摘Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO2 measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO2 levels allows evaluation of the accuracy of the tcPCO2 technique for use during jet ventilation. Design: Observational study;patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO2 (EtCO2) and transcutaneous CO2 (tcPCO2) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO2 (PaCO2) levels and tcPCO2 were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO2 values consistently provided a close approximation to PaCO2 levels. The mean difference between tcPCO2 and EtCO2 values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO2 provides an acceptable estimate of CO2 concentration in arterial blood during JV, as well as prior to and following JV.
